Vol 8, No 1 (2022)

Several trials have been conducted in the last decades that challenged the management of patients with acute pulmonary embolism (PE) in terms of diagnosis and treatment. Updated international clinical practice guidelines (CPGs) endorsed the evidence from these trials. The aim of this document was to adapt recommendations from existing CPGs to assist physicians in decision making concerning specific and complex scenarios related to acute PE. Methods: The flow for the adaptation procedure was first the identification of unsolved clinical issues in patients with acute PE (PICOs), then critically appraise the existing CPGs and choose the recommendations, which are the most applicable to these specific and complex scenarios. Results: Five PICOs were identified and CPGs appraisal was performed. Concerning diagnosis of PE when computed tomographic pulmonary angiography is not available/contraindicated and D-dimer is less specific, perfusion lung scan is the preferred option in the majority of clinical scenarios. For the treatment of PE when relevant clinical conditions like pregnancy or severe renal failure are present heparin is to be used. Poor evidence and low-level recommendations exist on the best bleeding prediction rule in patients treated for PE. The duration of anticoagulation needs to be tailored concerning the presence of predisposing factors for index PE and the consequent risk for recurrence. Finally, recommendations on the opportunity to screen for cancer and thrombophilia patients without recognized thrombosis risk factors for PE are reported. Overall, 35 recommendations were endorsed and the rationale for the selection is reported in the main text. Conclusion: By the use of proper methodology for the adaptation process, this document offers a simple and updated guide for practicing clinicians dealing with complex patients.

Smell and taste impairment are among the most common symptoms of COVID-19. Aim: to assess the patterns of olfactory and taste disorders associated with COVID-19 infection and their relationship with the clinical course of the disease. Material and methods. The cross-sectional survey enrolled 10348 young adults who had experienced taste and smell impairment during the COVID-19 epidemic. The patients were interviewed using an online questionnaire specially developed for the purposes of the work. The sampling has been stratified according to the severity of the disease course: mild (Group 1), moderate (Group 2), and severe (Group 3). Results. 7964 (77%) females and 2384 (23%) males aged from 20 to 40 were enrolled. The median age was 29 (24-36) for females and 29 (24-34) for males. A mild disease course was reported in 8454 (81,6%) cases, an average severity course was registered in 1486 (14,4%) respondents, and there were 408 (4%) cases of more than 50% bilateral polysegmental lung tissue involvement. Complete anosmia and ageusia was noted by 7225 (69,8%) respondents, insolated anosmia had occurred in 2641 (25,5%) cases, and 78 (0,7%) patients noted ageusia without olfactory dysfunction. Significant differences in the frequency of restoration of taste and smell in COVID-19 patients with different course severity were revealed. Before the disease onset, 534 respondents reported non-compliance with the recommended measures of self-isolation and respiratory protection, 1841 respondents continued to work out of home and use personal protection masks, 7846 persons reported a transition to remote job regime and use of individual masks when visiting public places. Conclusion. The development of taste and olfactory sense disorders in young patients with COVID-19 was associated with the disease course severity. Patients with severe coronavirus infection were significantly more likely to have a simultaneous violation of taste and smell, patients with mild and moderate severity were more likely to have anosmia without taste impairment. By the month since the disease onset, every other patient with mild disease course still retained complete or partial anosmia and ageusia. The subjects with moderate and severe COVID-19 course more often noted the restoration of taste and sense of smell by the end of the Month 1. The rate of recovery of taste and smell in young patients with COVID-19 was associated with the severity of the disease and compliance with self-isolation measures.

The purpose of the review is to present the actual data on the prevalence of anxiety and depressive disorders in patients with chronic heart failure (CHF); to consider the main pathogenetic mechanisms of the relationship in the development of psychoemotional disorders and cardiovascular diseases, with a focus at CHF. The article provides recommendations for performing depression and anxiety screening in patients with cardiovascular diseases; discussions of the prospects for managing such patients in the framework of interdisciplinary cooperation are also introduced.

MicroRNAs (miRNAs) are small non-coding molecules of ribonucleic acid (RNA). MiRNAs regulate gene expression at the post-transcriptional level by binding to the 3'-untranslated regions of the target miRNA. MiRNAs have been identified as key regulators of complex biological processes associated with multiple cardiovascular pathologies, including left ventricular (LV) hypertrophy, coronary artery disease (CAD), heart failure (HF), hypertension, and arrhythmias. MiRNAs in the bloodstream have been investigated as novel biological markers, especially in the context of acute myocardial infarction (AMI) and HF. In our review, we presented data on the role of miRNA in HF.

The review is devoted to the combination of two main modifiable risk factors for the development and progression of cardiovascular diseases (CVD) and premature deaths among people of working age - arterial hypertension (AH) and smoking. The author reminds practitioners of the clinical significance of the combination of hypertension and smoking, the peculiarities of the course of hypertension in smokers, the nuances of drug treatment of this combined pathology. It is hoped that the data presented will help to more effectively achieve target blood pressure levels in smokers with hypertension and improve disease control.

The presented clinical observation demonstrated the features of the course of the novel coronavirus disease 2019 (COVID-19) of kidney transplant patient. Possible causes of acute kidney injury and death were analyzed.

Beta-adrenoblockers (ß-AB) have proven their positive effect at the prognosis of patients with chronic heart failure (CHF) and low ejection fraction (EF) of the left ventricle (LV), with myocardial infarction and asymptomatic LV dysfunction. Activation of the sympathoadrenal system determines the necessity for prescribing this group of medicines, which is confirmed in controlled studies, and bisoprolol was the first ß-AB medicine that proved its effectiveness in CHF and low LVEF. Blockade of adrenergic receptors has a direct effect on cardiomyocytes and reduces the neurohumoral response. These advantages may also be applied to patients with CHF and LVEF of 40-49%, for whom b-AB therapy is more likely to help than harm. The benefits of ß-AB prescription for patients with CHF and LVEF ≥50% were not noted in order to make reliable conclusions about their effectiveness or safety. Considering all abovementioned information, the purpose of the review is to discuss the possibilities and prospects of prescribing cardioselective ß-AB, in particular bisoprolol, for multimorbid CHF patients.

Damage of nervous system structures during coronavirus infection is a very diverse process; among the other things, it affects also the genitourinary organs activity. Such kind of disorders can manifest themselves in disturbances of urination - a complex and polyhedral process of emptying the bladder, requiring complex interactions between the autonomic (sympathetic and parasympathetic) and somatic parts of the nervous system. These symptoms should be identified already at the first contact between the doctor and the patient, provided that they are well known and targeted for detection. An important role in the diagnosis of urological disorders (including those as complications of COVID-neuroinfection) plays the study of anamnesis, while we should not forget about the need for an individual approach to diagnosis, taking into account the individual peculiarities of the each patient. Drug therapy should be carried out both by an urologist and neurologist at the stage of therapy and also at the stage of rehabilitation.

Post-covid syndrome is one of the new problems that healthcare is faced during the COVID-19 pandemic. According to clinical studies results, up to one third of SARS-CoV-2 infected patients develop neurological symptoms which could last for months after regress of respiratory syndrome. The most common neurological disturbances associated with COVID-19 are fatigue, asthenia, cognitive impairment, smell and taste decrease, cerebral vascular disease, peripheral neuropathy, pain etc. Clinical symptoms of post-covid syndrome significantly affects the quality of life and working capacity of many patients. Nowadays therapeutic strategies of post-covid syndrome treatment are empirical and are based on possible pathogenesis of neurological complications. Prevention of cerebral vascular events and neurometabolic treatment of cognitive and asthenic disorders should play an important role in management of COVID-19 patients. Pentoxifylline could be considered as coadjuvant measure in treatment of post-covid neurological symptoms because of its multimodal effects.

The problem of failure to achieve the target blood pressure (BP) level remains actual for many countries in the world, including Russia. The modern strategy for the treatment of arterial hypertension (AH) is based on an integrated approach, including the correction of risk factors and prescribing of combined antihypertensive therapy at the stage of initial therapy, primarily for high cardiovascular risk patients. Combinations of calcium channel blockers of the dihydropyridine series and renin-angiotensin system, which have demonstrated the ability of significant reduction of the risk of cardiovascular complications development, are considered to be the most rational. A number of experimental and clinical studies have confirmed the high efficacy and safety of the fixed combination of amlodipine and losartan for BP control in people with AH. Taking all the abovementioned into account, the purpose of the review is to discuss the possibilities and perspectives for prescribing a fixed combination of amlodipine and losartan in multimorbid patients with arterial hypertension at high cardiovascular risk.